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STATEMENT OF BENEFITS 20� PAY 20 <br />4... REAL ESTATE IMPROVEME TS <br />Slate Form 51767 (R21 I -W) FORP S54 i meal Properly <br />Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies under the foilo6ving Indiana Corse (check one box)- <br />0 Redevelopment or rehabilitation of real estate improvements (iC <br />0 Eligible vacant building (IC 6 -1.1- 12,1 -4.8) <br />INSTRUCTIONS; <br />1. Thls stalernent must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires <br />information from the applicant in making its decision about whether to designate an Economic Ra0alizatlon Area. Otherwise this statement must be <br />submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. <br />"Projecle "planned or committed to aflor July 1, 1987, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -1.1 -12.1) <br />2. Approval of the designating body {City Council, Town Board, County Council, etc,) must be obtained prior to initiation of the redevelopment or rehabilitation, <br />BEFORE deduction maybe approved. <br />3. To obteln a deduction, application Form 322 ERAff2E or Form 322 ERA VBO, Whichever is applicetris, must be filed with the County Auditor by the later <br />of., (1) May 10; or (2) fhtrty (30) days after the notice of addition to assessed valuation or now assessment Is mailed to the property owner at the address <br />shown on the records of the township assessor. <br />4. property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF -1 10eat Property annually to the application to <br />show compliance with the Statement of Benefits. (1C 6 -1.1- 12.1- 5.1(b) and IC <br />5. The schedules established under IC 6 -1.1- 12.1 -4(d) for rehabilitated property and under IC 6 -1.1. 12.1- 4.8 {1) for vacant buildings apply to any statement <br />of benefits approved en or after July 1, 2000. The schedules effective prior to July 1, 2000, shelf continue to apply to a statement of beneGls died before <br />July 1, 2000. <br />Name of Taxpayer <br />BW Business Park LLC <br />Address of taxpayer (number and stroot, city. slate, and ZIP coda) <br />7101 Vorden Parkwa , South Bend, IN 46628 <br />Name of contact person Telephone number E -mail address <br />7'nnn NIAIAman f5741 287-231 1 tvaldmart0tirerack.com . <br />ante of designating body <br />Common Council <br />ocatiun of property <br />Vacant Land Par( <br />Current number <br />23.00 <br />Lots 14 & 16 in Blackthorn West <br />ements, redevelopment, or rehabiblallon {use r <br />Salaries <br />County <br />St . <br />necessary) <br />ember retained Salaries <br />23.00 1 $69C <br />Resolutlon number <br />IXGF taxing 6strict number <br />Estimated start date (month, day, year) <br />06/0112010 <br />Estimated complstlon date( Ah, day, year) <br />Number additional salarles <br />0.00 1 $0.00 <br />NOTE-, Pursuant to IC 6- 1.t- 12.1 -b.1 (d) (2) the COST of the properly REAL ESTATE. IMPROVEMENTS <br />is confidential, COST ASSESSED VALUE <br />Current values 23$ 000.00 <br />Plus estimated values of proposed project 2,400,000.00 <br />Less values of any property being replaced 0.00 <br />Net estimated values upon completion of project 2.638,000.00 <br />Estimated solid waste convatted (pounds) <br />diher benefits <br />I hereby certify that the representatlons in this statement are true. <br />Estimated <br />301 0A t� ?aGi <br />H <br />Signature of on ed repre "live Title bate s1pred ( monfh, day, year) <br />(f /f rCs io�ar 19 /P-6 t 7 <br />Page 1 of 2 <br />